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Work Related MSK disorders (RISK FACTORS (Lifting above shoulder height,…
Work Related MSK disorders
Benefits of work
Social Relationships
Better mental health
Pay
Lower mortality
Improved fitness
Reduced state benefits
Questions to ask
What exposures may have been harmful?
Is there anything hazardous about the job?
What is your job?
Hazards
Team leader (pressure and stress)
Fettler/Grinder
Machine operator
Foundry (metal being melted in furnaces)
Steeple Jack: People that go up buildings
Slinger (metal worker)
When might an illness be due to work?
Characteristic distribution of rash- I.e. placed hands in a mixture. Rash goes up to the elbow
Sensorineural deafness
Symptoms improve away from work i.e holiday
Cluster of cases in a workplace
Exposure to hazard --> work
Is the exposure causal of not?
Consistency in association. I.e someone else prooves the results are true
Specificity: disease is associated to one cause.
Use Bradford Hill criteria: Strength of association, consistency in association, exposure-response relationship, ODDS RATIO >2
Temproal relationship. Effect follows the exposure
Biologically plausible
Coherence of evidence
RISK FACTORS
Lifting above shoulder height
Heavy manual handling
Lifting below knee height
Incorrect manual handling technique
Forceful movements
Fast repetitive work
Poor posture
Rotator Cuff syndrome
Hawkin's sign
Normally happens to people that throw weights or people that lift things above their shoulders Painful arc. Changes in pain when lifting arm
Caused by tendonitis of a tear
Carpal Tunnel (flexor pollicus longus , 4x flexor digitorum profundus and 4x flexor digitorum superficially and the Median nerve that supplies LOAF
Foreceful repitive work done with abnormal wrist postures (non neutral structure) e.g. painters and meat processors
Obesity, short straure, hypothyroidism , RA and acromegaly
EPidemiology: 0/6% to 8% in women
Tinel's (tap on wrist) and Phalen's (prayer sign) provocative test
Prescribed Disease IIDB can be done to allow patient benefit
Example of prescribed disease
Carpal Tunnel Syndrome
Osteoarthritis
Secondary Raynauds from machinery
Bursitis
Tenosynovitus
Raynaud's Phenomenon
Triphasic colour change
You can get two componments: vascular and also sensori-neural effects. E.g. blanching, tingling, numbness and loss of dexterity
Secondary Raynaud's phenomenon . Vibrating tools
Trauma to the hand. I.e: Hypothenar hammer syndrome. Use Adson's test
Diabetes
Peripheral neuopathy
Differential diagnosis
Eligible for State Benefit. Jack hammers, chain saws, drills and grinders
Tenosynovitis
FInkelstein's test:
thumb in palm and flex digits over it. Hold onto wrist and ask then to bend their fingers. You may hear crepitations
NSAIDs and steriodal injections alongside rest
Commonly affects the Abductor pollicus longus and Extensor Pollicus Brevis . This is called DeQuervans tenosynovitis
Change job . As normally found in manual workers
Epicondylitis:medial (golfers) of lateral (tennis) side of the elbow
Tennis:
repeated extension and pronation. Use the
Cozen's test!!
Pain will be felt over the medial epicondyle . Pain is felt against the resisted extension of the wrist
Golf: repeated flexion and rotation . There is pain against the resisted flexion of the wrist
Treatment NSAIDs,steriodal injection, clasp, rest and pain relief
Repetitive strain disorder
Assoicated with a lot of keyboard work and secretarial work
Goes away with rest and an ergonomic computer keyboard
Non specific pain in the hand
Writer's cramp which is a focal dystonia. Associated with being a prescribed disease
Associated with epidemics once computers got introduced. Strong psychosomatic aspect.
Thoracic Outlet Syndrome
Compression of subclavian artery = white fingers
Lifts thing above their shoulders or have heavy weight on their shoulders e.g D of E
Hyperabduction syndrome that pinched the anterior scalene nerve that runs under the pec minor
Anterior scalene syndrome is pinching of the vessels and nerves between the scalene muscles
Costo clavicular syndrome: pinches the nerves underneath the collar bone
Vascular test using the Adson's sign. A process that is the loss of the radial pulse when the head is rotated to the ipsilateral side
Osteoarthritis
Osteoarthritis of knee: common in farmers and also in people who are carpet layers. Bursas can also develop.
Plantar fascitis
Farmers: osteoarthritis walking caused by excessive manual work. Recomend shoe inserts to correct abnormal biodynamics
Mechanical back pain
Neurological back pain: this is unilateral leg pain that is worse in the lower back radiates to the foot or toes. Motor , sensory or reflex change . Prognosis is reasonably high.
DD- sciatica
Simple back pain- early presentation. Mechanical in nature, recovery is likely
Red flags: need to think of the onset (either really young or old) and the re is systemic illness, constant progressive non mechanical pain / thoracic pain
Minor diseases
Bicipital tendonitis- use the speed test
Frozen shoulder (adhesive capsulitis) this is more common in women and the at risk groups are diabetic, thyroid and adrenal insufficiency. Equal restriction of active and passive movements
trigger Finger and Depuytren's this is a condition that is caused by inflammation and hypertrophy of the reticular sheath. Restricting the motion of the flexor tendon
Rapid Upper Limb Assessment (RULA)
It assess biochemical and postural loading on the whole body in particular the neck, trunk and upper limbs
Supposed to reduce the risk of injury developing
Looks at event driven posture and also where work related upper limb disorders are present
ADD 1 for either shoulder is raised, upper arm is abducted. Etc 5-6 point system is medium risk
Applied anthropometrics
Dynamic anthropometry: concern with the measurement of human beings at work . I.e looking at arm curves
Static anthropometry is concerned with the measurement of human subjects in a rigid standardized position
NEED TO THINK OF
TILE : TASK INDIVIDUAL LOAD ENVIRONMENT